Ces radiol. 2020, 74(2):114-121 | DOI: 10.55095/CesRadiol2020/021

Transcatheter therapy of the lower gastrointestinal hemorrhageOriginal article

Antonín Krajina¹, Ondřej Živný¹, Miroslav Lojík¹, Vendelín Chovanec¹, Jan Raupach¹, Petr Dvořák¹, Ondřej Renc¹, Petr Hoffmann¹, Jan Maňák², Petr Hůlek³

¹ Radiologická klinika LF a FN, Hradec Králové

² III. interní gerontometabolická klinika LF a FN, Hradec Králové

³ II. interní klinika LF a FN, Hradec Králové

Purpose: A retrospective analysis of transcatheter embolotherapy of the lower gastrointestinal hemorrhage is given from one center from period of 15 years.

Methods: Totally 57 patients (32 men, and 25 women of mean age of 68,4 years (ranged from 32 to 91 years) were referred to visceral angiography to localise extravasation and perform selective embolisation using a coaxial microcatheter. Only hemodynamically significant bleeding noncontrollable with full medicamentous and endoscopic therapy was indicated. Extravasations were localised with the CTA in territory of the jejunal, ileal and colic arteries, while in sigmodeal and rectal branches colonoscopy was dominant diagnostic method.

Results: Embolisation was performed in 38 (67%) patients out of 57. Nineteen (33%) patients were not embolised because of unproved extravasation. Embolisation was not performed in three patients (5%) with proved angiographic pathology, whom were not possible due to anatomical and technical reasons to perform selective catheterisation. These patients were treated surgically. Angiography was repeated in three embolised patients. In two of them for further source of hemorrhage and in one (2%) for previously embolised pathology. The most often embolised arteries were jejunal branches, frequency of embolisation of the each from colic arteries was equal. The microparticles were used most often, then acrylic embolic agent. The gelatin sponge was used in the territory of the internal iliac arteries.

Conclusion: The study revealed that anatomical localisation of extravasation or site of bleeding with CTA and/or endoscopically in a patient with lower gastrointestinal tract bleeding should lead as soon as possible to angiography and selective embolotherapy which is effective way to control such bleeding.

Keywords: angiography, embolisation, bleeding in the lower gastrointestinal tract

Accepted: April 6, 2020; Published: June 1, 2020  Show citation